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L.W. Randles Cheese Order Form
42879 US Route 36
Warsaw, OH 43844
Ph: 877-714-8326

Fax To: 740-824-3416
E-mail: cheese@lwrandles.com
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YOUR NAME ______________________________

ADDRESS__________________________________

__________________________________________

CITY______________________________________

 STATE_______                ZIP___________________

PHONE____________________________________

Email______________________________________

SHIP TO:

NAME__________________________________            GIFT CARD MESSAGE

ADDRESS_______________________________            _____________________________

_______________________________________             _____________________________

CITY___________________________________              ____________________________

STATE______ ZIP________________________               ____________________________

PHONE_________________________________               ____________________________

Method of Payment

Name on Card: ________________________    Visa___  Mastercard___
Card Number:__________________________   Exp. Date: ____-_____-_____

Item #

Description

Price

Quantity

Ext. Price

Shipping
           
           
           
           
           
           
 

Total

$

Please call for shipping charges due to the weight difference in the gift boxes and the different charges to particular states.
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42879 US Route 36  ~  Warsaw, OH 43844
Ph: 877-714-8326      Fax: 740-824-3416
E-mail: cheese@lwrandles.com

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